clinical decision rules for pulmonary embolism

Introduction

Elements of medical history & physical exam to designate the pretest probability of pulmonary embolism as 'likely' or 'unlikely' (see HOPPE score)

Laboratory

• a positive D-dimer test still warrants further investigation (CT vs VQ scan) if positive regardless of pretest probability

Diagnostic procedures

• ultrasound that identifies suspected DVT may eliminate radiation exposure & cost of CT angiography
  • apparently history of fracture without signs or symptoms of DVT is sufficient for suspicion

Notes

• Well's rule for deep vein thrombosis
• YEARS clinical decision rule
• Geneva score
• Wells score outperforms Geneva scores in ruling out pulmonary embolism in the primary care setting
• HOPPE score